London Calling: Interview with Garrett Emmerson, CEO London Ambulance Service

As he takes on his new role as Chief Executive of the UK’s busiest ambulance service, Garrett Emmerson talks about his transition from the transport to the health sector, how his skills and experience have helped him in making this change, and ultimately why London is his calling.

How would you describe your transition from the transport sector to health? Can you outline key highlights and learnings?

I have been here now for over six months, and I have to say that overall the transition has been a smooth and positive experience.

I was at Transport for London (TfL) for nine years, eight in my previous role, and I really did feel it was time for a change. I knew I was looking for something different, but I wanted a role which allowed me to use the skills and experience I had gained at TfL. I was not actively looking to join a specific sector, but knew I wanted to stay in London. When I was approached about this role it seemed to have a number of synergies with my thinking for my next step.

As the recruitment process progressed it became clear that the things that I wanted to do (and thought I could be good at) were also similar to what London Ambulance Service (LAS) felt they needed from a new Chief Executive. Throughout this time I was given a big opportunity to understand the challenges the organisation faced and, as a result there were no surprises when I joined.

It has been an interesting mix of the very familiar and the less familiar, which is what I expected. The terrorist attack at London Bridge was a very immediate challenge coming into the job, unfortunately an aspect of the job that is becoming familiar territory to many of us in the public sector. I had been involved at TfL when the attack at Westminster happened and then, within four days of starting at LAS, here we were dealing with London Bridge.

The operational side of the business and its challenges feel more familiar, as well as some of the other things we need to look at such as our estate, vehicle fleet, IT and corporate governance. These are of course similar across many sectors, but each individual organisation has its own unique issues.

What attracted you most to the role? Was it healthcare, or was it more specifically about this job at London Ambulance?

I think it was about this specific job, rather than the health sector itself. I wasn’t looking at a particular industry, but when I was approached I thought the role was very interesting, and I felt that my skills and experience could transfer over.

I did have previous knowledge of the London Ambulance Service having worked alongside the organisation on various areas in the past, including major incident response activity and resilience. I knew some of the challenges from a transport and logistics perspective, but the healthcare side was obviously new.

Before I joined, I knew that the service did amazing work. Seeing the LAS from the inside has only increased my admiration.

How you would you say your skills have transferred to the NHS? Are the pressures similar or different, and can you provide examples?

Coming as I did not only from outside the ambulance world, but also from outside the health service, I had to be clear about what I could bring to the role and the organisation to make sure my skills and experience tied up.

When you first join an organisation it is often easier to see what it is already good at delivering, and what needs to improve. The care the LAS provides is amazing, and the Care Quality Commission verifies this with its classification of the organisation as ‘outstanding’ for care. The job for me is about making sure the organisation as a whole is fit for purpose and can support the front line. This is why we are bringing in a diverse range of skills and capabilities into our workforce, which will make a real difference in the coming months and years.

Working with our Chairman, Heather Lawrence, we have now finalised our senior management team. This has been about getting the right balance of skills and not being constrained by background or sector, but also ensuring we maintain the core health sector organisational knowledge we need.

The challenges at the LAS are not particularly different to many of those faced by other public service organisations in London. Growing demand, growing population and growing economic success – challenges that most cities would love to have. These have manifested themselves slightly differently in the health sector than they have in the transport sector, but essentially we need to look at how we build a London that can address the needs and expectations of a city with a successful economy and a growing population to continue to deliver better health outcomes.

How have you been received in your new role, coming from outside the sector?

This was something I was very conscious of, taking on this role, but the reception has been so welcoming. You only have to look at what LAS has done in the past two years (by bringing in a raft of new clinical talent from overseas to tackle the shortages it had in the UK) to see that the organisation as a whole welcomes new people. This very much reflects the character of London these days by embracing diversity. The whole organisation has made my transition very smooth, and for that I am incredibly grateful.

What advice would you give to someone thinking about moving to a role in health from another sector?

My first piece of advice would be to do your homework and ensure that the organisation is right for you, and vice versa. That is very important. With my move it was vital for me and the team here that I had the appropriate skills and some existing knowledge of the wider London landscape, for example knowing the broader public and political environments and having managed an organisation at scale in the city. This is important and ensures there are no surprises for either party.

For the additional skills that were needed at executive level, it was also important for me to feel confident that they existed, or that we could recruit to ensure the future team would be successful. It was hugely important to ensure a strong and collaborative relationship with the chairman, board and the executive team from the beginning.

These areas were of fundamental importance to me as part of my move, and the whole process was very thorough to ensure that both LAS and I were comfortable that it was going to work. It really highlighted to me the absolute importance of getting that initial recruitment phase right in a way I had not recognised as keenly before.

Comparing the NHS to TfL, which do you think is the more political environment? Is bureaucracy more apparent in one or the other, or just different?

I would say they are different. The transport sector as a whole is substantially different in London as compared to any other part of the country, in the way it is set up as a part public, part private industry. The health sector in general is more regulated than the transport sector.

What I have observed is that the regulatory machine around the operation of the health sector is stronger but the political scrutiny perhaps less complex. Within transport in London there is a very complex set of political scrutiny arrangements, however these also provide an effective system of regulating and holding the service providers to account, just in a different way. For me, it has been about adjusting to a new environment and operating in a way which is appropriate for the sector as a whole.

How do you interpret the emphasis on partnership working within the NHS? Has this changed your approach – and if so, how?

Historically, ambulance services have perhaps been seen to be on the periphery of the wider NHS system and not at the heart of it, aligning themselves as much to the emergency services world as to the NHS. We are very clear that we want to evolve that. We want to be at the centre of developments in the urgent and emergency care agenda in London and, to do that, we need to work closely with the Sustainability and Transformation Partnerships (STPs).

Looking at the NHS overall, it feels like we are still at an early stage in the evolution of STPs, so we are not playing catch-up or trying to change established partnerships. It feels like there is a set of new and dynamic opportunities to grow partnership working, both with the public and private sectors.

It is quite interesting the way the five STPs are developing. They are actually not very different to sub regional transport partnership areas in London. Putting these two areas (transport and health) in touch with one other can potentially open up benefits to both, for example, in terms of road safety and air quality. I am utilising my networks to join people across different organisations, and this has opened up access points and moved forward some work more quickly than might have been possible previously. My ability to do this may wain as I move more into the healthcare space, but that is one of the nice things about stepping across sectors as it does enable you to do “joining up” that may be harder to do otherwise.

Considering your transition into healthcare, what would you highlight as the most exciting and the most challenging elements about the sector?

The growth agenda is the key challenge for the London Ambulance Service; more specifically, the city’s growth and the demand this is placing on the health and emergency services. For me this is a very exciting element about London and public provision in general.

Due to the nature of these challenges however, I believe it needs a long term approach to deliver the required scale of change. In the transport sector, which is heavily infrastructure focused, we are used to things taking longer to deliver, and we are used to looking 15-20 years ahead. This is less typical in healthcare and something I am focusing on at LAS. I want to encourage big system thinking, and how we can quantify and effect organisational change and deliver greater benefits.

Playing a more active part in the wider city planning role is something I have encouraged the organisation to do as a priority, working with other sectors and the Mayor of London’s office. It is not an area LAS has played an active role in before, but it is going to be important to us in the future. There is help and support out there that we can use to our benefit and help to raise greater awareness amongst our stakeholders about how we operate and challenges we face.

Today we operate much more like a modern private hire or mini cab company, on every street, responding on a job-by-job basis, rather than waiting in ambulance stations until we’re needed, as the public often think. We need to change these perceptions to help people understand how we need to evolve in the future.

One other area of challenge is political and media scrutiny. This is a challenge across all emergency services or public provision, but in London you are right under the nose of both regional and national decision makers. When you get it right, and when you get it wrong, it is there for all to see. This is the challenge of working in London, but it’s also a great opportunity for the organisation to shine on a national as well as regional stage.

In your most recent career you have been in London-wide leadership roles and therefore have a very broad view across many elements of the city and surrounding areas. What would you choose to highlight that excites you about London’s future?

I was brought up in London and the South East. I have had a career which has taken me all around the country and provided me with amazing experiences. However ultimately, I wanted to live and work in London more than anywhere else. It is one of the great cities of the world. It is a city which has huge capabilities and great aspirations. It does also have huge expectations of its public services. People in London demand the best, expect things to be done yesterday, and to be more efficient and with better outcomes. You just know that second best is not good enough. That excites and motivates me hugely!

It is such a vibrant place to work and you are surrounded by so many capable people, not only here at LAS but across lots of other organisations and sectors. The ‘can do’ attitude is real and exists across the city. It is not just specific to health, but endemic to the culture of London and the people who live and work here. When I first moved into London to start working, I really noticed that people have a mind set to change things and I believe that is why so much happens here first, in London.

The city faces a time of change with Brexit, but so does the whole country. Only time will tell what the actual impacts will be. In terms of the health sector it could impact on our ability to recruit and retain key staff, but we just don’t know for sure. At LAS we have never been constrained by looking solely within the EU for staff. We will continue to look globally and I believe London will too, more generally. In the greater scheme of London’s history, this is just one more adaptation for us to make.